Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors

Young Kyeong Seo; Jung Sik Choi

doi:10.4166/kjg.2018.72.4.217

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Seo and Choi: Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors

Case Report

Korean J Gastroenterol 2018;72(4):217-221.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.72.4.217

Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors

Young Kyeong Seo, Jung Sik Choi¹

Division of Gastroenterology, Department of Internal Medicine, Seoul You Hospital, Busan, Korea

¹Division of Gastroenterology, Department of Internal Medicine, Busan Paik hospital, Inje University College of Medicine, Busan, Korea

Correspondence to: Jung Sik Choi, Division of Gastroenterology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6270, Fax: +82-51-892-0273, E-mail: jschoi@paik.ac.kr, ORCID: https://orcid.org/0000-0002-4235-0522

Received 18 March 2018 Revised 17 May 2018 Accepted 23 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Neuroendocrine tumor (NET) of the major duodenal papilla is a rare occurrence. However, that of the minor duodenal papilla is even rarer. To date, only a few cases have been reported. Herein, we present a rare case of NETs detected at the major and minor duodenal papilla synchronously, which were successfully treated with endoscopic papillectomy without procedure-related complication. To the best of our knowledge, this is the first report of this kind in the world. Photomicrograph of the biopsy specimen stained im-munohistochemically for synaptophysin showed a positive reaction of tumor cells. All resection margins were negative. Further experience with more cases will be needed to establish the exact indication of endoscopic papillectomy for duodenal papillary NETs.

Keywords: Neuroendocrine tumors, Major duodenal papilla, Minor duodenal papilla

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Fig. 1.

MRCP image showing clinically normal biliary tree and pancreatic duct. MRCP, magnetic resonance cholangiopancreatography.

Fig. 2.

Side-viewing duodenoscopic findings for minor duodenal papilla. (A) Endoscopy showing an enlarged tumor at the minor duodenal papilla, with shallow ulcers and ectatic vessels at the top of the tumor. (B) Gross finding of the resected specimen after endoscopic snare minor papillectomy.

Fig. 3.

Pathologic findings of a neuroendocrine tumor of the minor duodenal papilla. (A) On low-power view, glandular proliferation of tumor cells was seen in mucosa and submucosa. Lymphovascular and perineural invasion was not observed (H&E, ×40). (B) On high-power view, tumor cells were monomorphic and uniform-sized, showing a trabecular, rosette pattern with small round cells featuring small round nuclei and pink-to-pale cytoplasm (H&E, ×400). (C) Tumor cells showing positivity for Ki-67 (Ki-67 stain, ×200). (D) Tumor cells were reactive to synaptophysin immunohistochemistry, evidence of neuroendocrine neoplasm (synaptophysin stain, ×200).

Fig. 4.

Side-viewing duodenoscopic findings for major duodenal papilla. (A) Endoscopy showing a rather prominent major duodenal papilla, but with preserved configuration. There were hyperemic granular changes and ectatic vessels. (B) Gross finding of the resected specimen after endoscopic snare major papillectomy.

Fig. 5.

Pathologic findings of a neuroendocrine tumor of the major duodenal papilla. (A) On low-power view, tumor cells were limited to submucosa. Lymphovascular and perineural invasion was not seen (H&E, ×40). (B) On high-power view, tumor cells were monomorphic, uniform-sized, and showed a trabecular, rosette pattern with small round cells featuring small round nuclei and pink-to-pale cytoplasm (H&E,×400). (C) Tumor cells showing positive reaction for Ki-67 (Ki-67 stain, ×200). (D) Tumor cells were reactive to synaptophysin immunohistochemistry, evidence of neuroendocrine neoplasm (synaptophysin stain, ×100).

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ORCID iDs: Jung Sik Choi
https://orcid.org/0000-0002-4235-0522
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